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This chapter begins with a discussion of the changing aims of medicine, from the originally simple purpose of making a diagnosis, followed by attempting a cure and if that were not possible, then trying to palliate the consequences, into broader and more humanistic objectives. The first of these modern objectives is the increasing investment into prevention and earlier detection of disease, reflecting the current view that earlier intervention with many diseases may result in a better chance of disease eradication. The discussion then covers the factors determining symptom perception and the success of palliation, care of dying patients; models of palliative care; palliative medicine as a specialty; implementing a comprehensive supportive care network; who could benefit from comprehensive supportive care; constituents of a supportive care network; the relationship between supportive care and palliative care; end of life care; and assisted dying and euthanasia.

This chapter discusses supportive care, which centres on the patients of ESRD and focuses on the wishes and goals of the individual. Thanks to the team-based approach of ESRD patient care, programmes for the management of ESRD should have supportive care, along with routine prevention, diagnosis, transplantation, and RRT. This chapter includes sections on supportive care in nephrology practice, the need for supportive care, and palliative and end-of-life care.

This chapter provides an introduction to the concept of supportive care in heart failure (HF). It starts by presenting the concepts of supportive and palliative care. It addresses the delivery of supportive care and the framework for supportive care in HF. It is shown that the comprehensive HF care combines evidence-based HF care and supportive care. Further study is important to determine how best to enhance quality of life and reduce the symptoms and burdens associated with HF. While challenges presented by delivery and reimbursement systems may require organized schemes to achieve comprehensive HF care, framing supportive care as integral to comprehensive HF care allows clinicians to better meet the needs of the patient and family now recognized as essential to ‘patient-centered care’.

This chapter examines the nature of palliative and its contribution to supportive care. The findings indicate that the modern approach to medicine now holistically embraces the subjective needs of patients and their carers and that hospices and the modern palliative care movement have made major progress in the care of dying people. The chapter suggests that palliation of symptoms should be considered analytically and that treatment should be applied using modern scientific principles.

This chapter discusses the notion of supportive care in dementia. It explores the application of aggressive biomedical treatments as a component of supportive care, in the context of treatments arising in patients with typical late-onset dementias such as Alzheimer's disease and vascular dementia. It fleshes out the explanatory model of supportive care in specific ways, and then says something further about logistics.

This chapter highlights some of the points that the authors of the preceding chapters have made. It summarizes the issues that emerge. It derives from what has already been said the ingredients of a supportive care dementia service. It then looks forward to the chapters that follow as they discuss the potential elements of supportive care.

In England, the Department of Health White Paper, Our Health, Our Care, Our Say declared that personalized services would be the way forward for social care. Indeed, policy in England speaks of the need to transform adult social care. Everyone who receives health and social care support, whether from statutory services or through funding support for themselves, will in theory have choice and control over how that support is delivered. The goal is that they will be confident that services are of high quality, are safe, and promote individuals' independence, wellbeing, and dignity. Central to these aspirations are people with dementia. The National Dementia Strategy reflects this same approach, being produced as part of the Putting People First policy, which is the cross-departmental commitment to this move to personalizing social care. If supportive care is to be at the heart of mainstream social care for people with dementia in England, then its proponents will need to understand this ethos of personalization and to decide whether its value base fits with an orientation to supportive care. Dementia care practitioners have an important role in shaping personalization and responding to its ambiguities. This chapter explores these relationships, and, in doing so, takes a critical look at ideas of ‘supportive care’. Social work and social care have long experience of terminology being used rather indiscriminately and as cloaks to cover substantial changes. Previous policy documents and discussions have used the term ‘community’ to mean a number of things for example. Likewise, ‘care’ too is a term that conveys political and gendered undercurrents and values. Thus the current fashion for the replacement of ‘care’ by ‘support’ may signal shifts in values, responsibilities, and roles of great depth or superficiality.

A significant proportion of people living with dementia will live and stay in long-term care settings. Consequently, care homes have an important role to play in the provision of supportive care for people with dementia. This chapter initially describes the care home context, as this shapes the experiences of living and dying for people with dementia residing in care homes. It draws on two recent studies, both considering the provision of palliative care for people who are living and dying in care homes: one from the UK (Froggatt) and one from Australia (Parker). From this empirical research it identifies two key challenges that face care homes as they support people with dementia living in such settings: how do we, on the one hand, create a culture of openness to people's experiences of living and dying alongside, on the other hand, maintaining people's identities? These both require attention in the care home setting if person-centred supportive care is to be provided throughout a person's life until their death.

This chapter considers the conceptual problem: how do we characterize the care that is due to people with dementia in such a way as to capture all its possible, desirable, and necessary aspects? It identifies the problems lying behind the conceptual question as being to do with the dichotomies and divisions inherent in the different approaches to dementia care. The conceptual conclusion has led in the direction of supportive care, which is a suitable way to characterize the nature of the care owing to people with dementia. Even at this preliminary stage, the supportive care model envisaged allows room for the full benefits of the palliative care approach and good quality end-of-life care to be harnessed, whilst still accommodating the biopsychosocial and spiritual dimensions of holistic care from the time of diagnosis.

Huntington's disease (HD) is an inherited neurodegenerative disorder for which there is currently no known cure. Disease onset usually occurs around thirty-five to forty-five years of age and may be signalled by early cognitive changes that progress to dementia; voluntary and involuntary movement disorders such as bradykinesia, akinesia, postural instability, chorea, dystonia, and dysphagia; and emotional changes such as depression, aggression, apathy, and anxiety. HD can be challenging for people with the disease and their families owing to the combination of dementia, movement disorders, and emotional changes. This chapter discusses supportive care in HD, models of supportive care, supportive care for people who are at risk or pre-symptomatic, and supportive care for people in the early, middle, or late stages of the disease.

The nature of general practice and the concept of supportive care appear to be closely linked. Similarities include a multi-disciplinary, holistic approach to patient care, with an emphasis on continuity of care from the point of diagnosis to a patient's death. The primary care team, and in particular, the role of the family doctor or GP, would seem to be pivotal in the co-ordination and delivery of supportive care for people with dementia. In theory, the GP should possess an in-depth knowledge of the person with dementia, their immediate family, and community support networks and be able to assess their physical, psychological, and social needs, as well as the needs of their main carers. This chapter reflects upon the role of the family doctor in the provision of supportive care for people with dementia, examines existing evidence concerning the delivery of such care, and considers how they might improve upon this.

This chapter discusses changes in the area of renal supportive and palliative care that have evolved in the United Kingdom and the United States. It also includes an overview of strategy developments and clinical demonstration projects to help illustrate the topic. It has been determined that ESRD has become a geriatric disorder, with demographics revealing an increase in the severity of co-morbid diseases.

Serious illness and impending death focus one's attention on ultimate concerns, and these are precisely the issues that religion has always addressed. In short, scientific medicine may be able to provide us with the means to live longer and healthier lives, but it is utterly powerless to offer us any meaning to live for. But that is precisely what spiritual care offers and, therefore, why it is so crucial in supportive dementia care. This chapter discusses the challenges of discussing the spiritual dimension of supportive care for persons with dementia and their carers, the complication posed by the many different spiritual paths people currently follow, and basic principles of supportive spiritual care.

This chapter begins by considering the mode of death in patients with heart failure (HF). Death from progressive systolic HF is discussed. Prediction models have been developed to assist in risk stratifying patients with HF. The chapter also addresses the inotrope dependent and transplant eligible patients. It then shows the studies of patients at the end-of-life and diastolic HF. Barriers to supportive care and supportive care and the course of illness in HF are described as well. To sum up, supportive care may likely benefit patients throughout the course of HF, even as early as the time of diagnosis. Ideally, this would involve an ongoing accessibility to and reimbursement for supportive care resources throughout the course of the illness in combination with strong communication between the various clinical disciplines caring for these patients.

This chapter considers how supportive care can relieve symptoms due to chronic diffuse airflow obstruction and pulmonary or pleural disease that causes lung restriction. Together these conditions are responsible for the largest number of respiratory patients who may need supportive care. The first part of the chapter considers the diseases causing chronic diffuse airflow obstruction and briefly discusses their pathophysiology and prognosis. It then looks at the measures available for supportive care and briefly summarizes the evidence for each of these.

The aim of assisted living programmes in the US is to provide a stable place of residence for older people who would otherwise be unable to live independently. The hope is that quality of life will be maximized through meaningful activity and support. The intention is that assisted living should prevent the need for admission to hospitals or nursing homes, although both of these outcomes occur quite frequently. Research shows that a good proportion of people in assisted living have dementia, and it seems possible in many cases to maintain relative independence even until the end of life. This chapter discusses the emergence of assisted living as a dementia care setting, the needs of persons with dementia in assisted living, supporting daily living and quality of life, supporting the person with end-stage dementia, and dementia-specific assisted living units and facilities.

The guidelines presented in this book should give some insight into the advantages that result from an atmosphere of mutual cooperation. The discussion notes that managing the distress and the symptoms of advancing cancer, and being prepared to work alongside the primary team, may greatly reassure patients. Families and the professional are most likely to appreciate the extra dimension of supportive care that can be offered. This allows one to become part of a truly integrated service; offering a balanced approach to patients and families who are struggling to come to terms with the devastating impact of advanced cancer.